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Course of pulmonary dysfunction in children surviving Pneumocystis carinii pneumonitis. A prospective study
Insights
Children surviving Pneumocystis pneumonia typically recover lung function within six months. Most children showed initial pulmonary dysfunction, but serial studies revealed significant improvement, indicating no long-lasting pulmonary sequelae from this infection.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pneumocystis carinii pneumonia (PCP) can cause significant morbidity in children.
- Long-term pulmonary sequelae after childhood PCP are not well-characterized.
Purpose of the Study:
- To assess serial pulmonary function in children after surviving acute PCP.
- To determine if childhood PCP leads to lasting lung damage.
Main Methods:
- Serial pulmonary function tests (spirometry, gas transfer factor, blood gases) were performed on 23 children (7-18 yrs) post-PCP.
- Follow-up intervals included hospital discharge, 1, 3, 6, and 12 months.
- Histopathology was examined in non-survivors.
Main Results:
- 17 of 23 children initially had pulmonary dysfunction, most commonly reduced pulmonary gas transfer factor and restrictive disease.
- Arterial hypoxemia at rest was present in nine cases, related to intrapulmonary shunting.
- Pulmonary function significantly improved within 1 month and resolved by 6 months in all survivors.
- No residual interstitial fibrosis or alveolopathy was noted in deceased patients.
Conclusions:
- Childhood Pneumocystis carinii pneumonitis generally does not result in long-term pulmonary sequelae.
- Pulmonary function deficits resolve within six months in most survivors.
- Recovery is independent of oxygen therapy duration, ventilatory support, or initial radiographic findings.
Abstract:
Pulmonary function studies were done serially in 23 children 7 to 18 yrs of age who had survived the acute stage of Pneumocystis carinii pneumonitis. Each child was asymptomatic. Spirometric indices, expiratory flows, pulmonary gas transfer factor, arterial blood gases, and other clinical variables were assessed a few days before patients were discharged from the hospital and at 1-, 3-, 6-, and 12-month intervals thereafter; two patients developed recurrent pneumonitis during follow-up and were studied twice. All but five subjects had pulmonary dysfunction when tested initially. A decrease in pulmonary gas transfer factor, observed in 17 studies, was the most common abnormality. Restrictive pulmonary disease was seen in 11 studies; an obstructive component, in one. Arterial hypoxemia at rest, while patients were breathing room air, was noted in nine cases. Roentgenographic evidence of bilateral diffuse lung opacities was seen in 11 patients and was positively correlated with decreases in pulmonary gas transfer factor (p less than 0.001). Arterial hypoxemia was significantly related to intrapulmonary right-to-left shunt (p less than 0.001) but not to decreases in pulmonary gas transfer factor, indicating the importance of ventilation-perfusion abnormalities in these patients. Serial follow-up studies disclosed significant improvement in pulmonary function deficits within 1 month and complete resolution by 6 months in all survivors. Recovery was not related to the amount of duration of O2 therapy, to the need for ventilatory support, or to chest roentgenographic abnormalities. Histopathologic findings in nine patients who died during follow-up did not indicate any residual interstitial fibrosis, collagen deposits, or alveolopathy. We conclude that Pneumocystis carinii pneumonitis during childhood does not typically produce long-lasting pulmonary sequelae.